Billing code 46230: Anal tag excisionMedicare rate & RVUs in Guam
Excision of multiple anal skin tags is reported when a clinician surgically removes more than one symptomatic tag from the anal area.
Medicare pays $368.65 for 46230 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 46230 covers
This procedure removes multiple external anal skin tags, which are folds of skin that may cause irritation or make hygiene difficult. A colorectal surgeon or other qualified clinician typically performs the excision in an office or outpatient surgical setting, using local or other appropriate anesthesia. The operative work is directed at the tags themselves, rather than removal of hemorrhoidal tissue or treatment of a fissure.
Report 46230 when multiple anal tags are excised; the operative note should identify the tags removed and document the procedure performed. A single anal papilla or tag is represented by the related single-tag code, 46220. The service has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
46230 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $368.65 | $168.51 |
How the 46230 rate is calculated
Each of 46230’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46230
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.55Practice expense 7.22Malpractice 0.48
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46230
46230 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46230
Anal tag excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46230
Anal tag excision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46230 without 51 · national office
$342.36
Anal tag excision
46230-51 · Second procedure: 50%
$171.18
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
46230 compared with similar codes
Compare codes
46230 vs 46220 vs 46250 vs 46255: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46220Anal tag excision
- 46220 represents excision of a single anal papilla or tag; 46230 is for multiple anal tags.
- 46250Hemorrhoidectomy
- 46250 is for excision of multiple external hemorrhoid groups. Choose 46230 when the excised tissue consists of multiple anal skin tags.
- 46255Hemorrhoidectomy
- 46255 applies to excision of one internal and external hemorrhoid group, rather than multiple anal skin tags.
46230 billing questions
When should 46230 be selected instead of 46220?
Use 46230 when multiple anal tags are excised. Code 46220 represents excision of a single anal papilla or tag.
Can anal tag excision be reported as hemorrhoid removal?
No. 46230 describes removal of multiple skin tags; hemorrhoidectomy codes apply when hemorrhoidal tissue is excised. The operative note should make clear which tissue was treated.
Are related postoperative visits separately payable during the global period?
Related postoperative visits for 10 days are included in the global period for 46230.
Should modifier 50 be appended for tags on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be billed for 46230?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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